Radiation safety has always been central to medical imaging. At the heart of that commitment is ALARA—“As Low As Reasonably Achievable.”
While the principle itself hasn’t changed, the way we apply ALARA in 2025 looks very different from even a decade ago.
Today’s technologists work in an environment shaped by:
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AI-powered dose management tools
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New regulatory requirements
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Updated shielding recommendations
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Revised pediatric imaging guidelines
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Rapidly increasing CT volumes
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Fluoroscopy dose monitoring mandates
In other words, ALARA is no longer just a philosophy—it’s a measurable, trackable, and highly technical part of everyday workflow.
In this article, we’ll explore what ALARA means in 2025 and how CT, fluoroscopy, and general radiography technologists can apply modern best practices to protect patients, themselves, and their colleagues.
The Three Pillars of ALARA
Even with all the technological advances, ALARA still rests on three foundational principles: time, distance, and shielding. These remain as relevant today as ever—only the tools have evolved.
1. Time: Minimize Exposure Duration
Radiation dose increases with exposure time. The less time radiation is being produced, the lower the dose.
In 2025, reducing exposure time includes:
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Shorter fluoroscopy times
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Using pulsed fluoroscopy instead of continuous mode
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Last-image hold instead of re-exposing
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Pre-planning interventional procedures
In fluoroscopy, pulsed rates such as 7.5 or 15 pulses per second (pps) are often sufficient for diagnostic quality while dramatically reducing dose compared to continuous fluoro.
Similarly, careful planning before complex interventional procedures reduces unnecessary beam-on time. A few minutes of preparation can save significant radiation exposure.
Time management isn’t about rushing—it’s about efficiency.
2. Distance: Step Back, Reduce Dose
Distance remains one of the most powerful and underutilized radiation safety tools.
Thanks to the inverse square law, doubling your distance from the source reduces your exposure to one-fourth. That’s exponential protection.
Modern best practices include:
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Using positioning devices instead of holding patients
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Stepping back during exposures
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Maximizing distance when working with C-arms
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Standing on the detector side of the patient when possible
In mobile C-arm procedures, positioning yourself on the detector side rather than the tube side significantly reduces scatter exposure.
Small positioning adjustments can make a major difference over the course of a career.
3. Shielding: Updated for 2025
Shielding practices have evolved significantly in recent years.
What’s changed?
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Routine patient gonadal shielding is decreasing in use.
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Staff shielding remains mandatory.
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Mobile protective barriers must be readily available.
Why the shift away from routine patient shielding?
Research has shown that improper placement can interfere with imaging, trigger automatic exposure control (AEC) systems to increase dose, and often provides minimal benefit due to modern beam collimation and lower exposure techniques.
However, staff protection remains non-negotiable. Lead aprons, thyroid shields, lead glasses, ceiling-suspended shields, and mobile barriers continue to play a critical role in occupational dose reduction.
The message for 2025: shielding is still essential—but it must be used appropriately and intelligently.
ALARA in CT
CT has become one of the most powerful—and most utilized—imaging modalities. With rising CT volumes nationwide, dose optimization is more important than ever.
Here’s how ALARA applies in modern CT practice:
Use the Lowest kVp Compatible with Diagnostic Quality
Lower kVp techniques can significantly reduce dose, particularly in smaller patients and pediatric exams. Advances in reconstruction algorithms now allow lower kVp settings without compromising image quality.
Automatic Exposure Control (AEC)
AEC systems automatically modulate mA based on patient size and anatomy. Proper use of AEC ensures patients receive only the dose necessary for diagnostic imaging.
Iterative Reconstruction (IR) and AI Reconstruction
Modern iterative and AI-based reconstruction techniques reduce image noise, allowing lower radiation output while maintaining clarity.
This has been one of the biggest dose-reduction breakthroughs of the past decade.
Protocol Standardization
Standardized, reviewed protocols reduce variability and prevent unnecessary multiphase exams. Each additional phase increases dose—so eliminating unnecessary phases is one of the simplest ALARA wins.
Monitor CTDIvol and DLP
Tracking CTDIvol and DLP is no longer optional. Many facilities now use dose-monitoring software that flags outliers and helps ensure compliance with regulatory standards.
ALARA in CT is no longer guesswork. It is measurable, auditable, and continuously improving.
ALARA in Fluoroscopy
Fluoroscopy presents unique challenges because exposure can continue for extended periods.
Modern strategies include:
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Pulsed fluoroscopy (7.5 or 15 pps)
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Tight collimation
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Minimizing magnification modes
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Standing on the detector side
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Continuous dose monitoring
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“Time-outs” during lengthy procedures
Magnification mode increases dose significantly. Use it only when absolutely necessary.
Many institutions now require dose monitoring alerts during longer procedures. A brief “radiation time-out” allows the team to reassess technique, positioning, and beam-on time.
Fluoroscopy safety is now a team responsibility—not just the technologist’s.
ALARA in General Radiography
Although general radiography involves lower doses than CT or fluoroscopy, repeat exams and poor technique can still increase cumulative exposure.
Key strategies include:
Tight Collimation
Collimation reduces patient dose and improves image quality by decreasing scatter. It is one of the simplest and most effective ALARA tools.
Correct Exposure Techniques
Using technique charts and selecting appropriate kVp and mAs for patient size prevents overexposure and repeat exams.
Avoid Repeats
Careful positioning, clear communication, and immobilization when needed dramatically reduce repeat rates.
Proper Use of AEC
When using AEC, ensure correct positioning over the detector chambers. Avoid placing shielding over AEC sensors, which can cause the system to increase exposure.
Follow Updated Shielding Guidelines
Understand current recommendations and explain them confidently to patients who may expect shielding based on older practices.
Consistency and attention to detail are what keep general radiography aligned with ALARA principles.
Pediatric ALARA in 2025
Children are more radiosensitive than adults, making dose reduction especially important.
Modern pediatric ALARA includes:
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Weight-based technique charts
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Reduced kVp settings
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Limiting repeat imaging
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Avoiding shielding over AEC regions
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Parental education
Weight-based protocols ensure that exposure is tailored to the child’s size—not based on adult settings.
Lower kVp techniques, combined with advanced reconstruction methods in CT, allow for excellent image quality at dramatically reduced doses.
Equally important is communication. Parents often have concerns about radiation exposure. Explaining how dose is minimized builds trust and reduces anxiety.
Pediatric ALARA isn’t just technical—it’s educational.
AI’s Role in ALARA
Artificial intelligence is transforming radiation safety.
AI improves dose optimization through:
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Dose prediction models
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Anatomy recognition
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Automated parameter selection
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Noise reduction
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Artifact suppression
AI-powered systems can analyze patient anatomy and recommend optimal exposure settings in real time. Some platforms flag protocols that exceed established benchmarks before the scan even begins.
Advanced noise-reduction algorithms allow technologists to lower technique factors while maintaining diagnostic confidence.
The result?
Significant dose reductions without sacrificing image quality.
AI doesn’t replace technologists—it enhances decision-making and supports safer imaging practices.
How Gage CE Supports Your ALARA Initiatives
Staying current with evolving radiation safety standards is not optional—it’s a professional responsibility.
At Gage CE, we offer continuing education designed specifically for X-ray, CT, and MRI technologists who want to stay ahead of regulatory updates and technological advancements.
Our relevant courses include:
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CT Dose Optimization
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Radiation Safety Fundamentals
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Fluoroscopy Safety
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Pediatric Imaging Essentials
Each course is designed to translate complex guidelines into practical, real-world applications you can use immediately in your clinical setting.
Whether you’re updating protocols, preparing for inspections, or simply strengthening your expertise, continuing education ensures you remain confident and compliant.
ALARA in 2025: A Culture of Safety
ALARA is no longer just a principle posted on the wall. It is:
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Embedded in AI-driven technology
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Monitored through dose-tracking software
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Reinforced by regulatory standards
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Reflected in updated shielding practices
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Supported by continuing education
As imaging volumes increase—especially in CT—the responsibility to minimize radiation exposure becomes even more important.
By focusing on time, distance, shielding, protocol optimization, and emerging AI tools, technologists play a direct role in protecting patients and themselves.
Radiation safety is not about limiting diagnostic capability. It is about delivering the right dose, for the right patient, at the right time.
That is ALARA in 2025.
And it starts with you.